Provider Demographics
NPI:1386737039
Name:BATES, JILL MARIE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:BATES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LOS OSOS VALLEY ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402
Mailing Address - Country:US
Mailing Address - Phone:805-534-9373
Mailing Address - Fax:805-534-9373
Practice Address - Street 1:900 LOS OSOS VALLEY ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402
Practice Address - Country:US
Practice Address - Phone:805-534-9373
Practice Address - Fax:805-534-9373
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39618106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist